Hill W A, Jackson D H, Maurer B J, McDaniel H G, Soto B, Reeves T J, James T N
Recent Adv Stud Cardiac Struct Metab. 1975;10:159-78.
Hemodynamic and metabolic responses to pacing from either the coronary sinus or right atrium were evaluated in 41 patients with chest pain and normal coronary arteriograms. A group of patients (group II) with angina, lactate production, or significant ST segment depression had a significantly higher mean pulmonary capillary pressure on peak pacing or angina than did a group of patients considered to have a normal pacing response (group I). In 6 of 9 group II patients, the left ventricular end-diastolic pressure either rose abnormally with pacing or was greater than 14 mm Hg immediately after pacing and resembled that of a group of patients with coronary artery disease; Patients with a prolapsing mitral valve (group III) also had a significantly higher pulmonary capillary pressure on peak pacing as compared to those of group I, although abnormal left ventricular pressure responses occurred in only 2 of 9 of these patients. The stroke index was significantly lower in group III on peak pacing while group II was no different from group I. Lactate production occurred in 6 of 9 group II patients. However, only 1 of 6 patients with a prolapsing mitral valve who were studied for lactate production was found to produce lactate, suggesting a different mechanism for their pain.
对41例胸痛且冠状动脉造影正常的患者评估了经冠状窦或右心房起搏时的血流动力学和代谢反应。一组有胸痛、乳酸生成或明显ST段压低的患者（II组）在起搏高峰或胸痛发作时的平均肺毛细血管压显著高于一组被认为起搏反应正常的患者（I组）。在9例II组患者中的6例，左心室舒张末期压力在起搏时异常升高，或在起搏后立即大于14 mmHg，类似于一组冠心病患者；二尖瓣脱垂患者（III组）在起搏高峰时的肺毛细血管压也显著高于I组患者，尽管这些患者中只有9例中的2例出现了异常的左心室压力反应。III组在起搏高峰时的每搏指数显著低于I组，而II组与I组无差异。9例II组患者中有6例出现乳酸生成。然而，在6例接受乳酸生成研究的二尖瓣脱垂患者中，只有1例被发现有乳酸生成，提示其疼痛机制不同。
